Northland College Athletics - Sickle_Cell_Trait_Status_2016.pdf

May 2, 2016 - The Official Website of Northland College Athletics. Jack Sports. Baseball · Basketball ... Download Sickle_Cell_Trait_Status_2016.pdf Open ...

Sickle Cell Trait Status SICKLE CELL TRAIT FACTS o o o


Sickle Cell Trait is a common condition (>3 million Americans) Sickle Cell Trait is an inherited condition of the oxygen-carrying protein, hemoglobin, in the red blood cells Although Sickle Cell Trait is most predominant in African-Americans and those of Caribbean, Indian, Mediterranean, Middle Eastern, and South and Central American ancestry, persons of all races and ancestry may test positive for Sickle Cell Trait. Sickle Cell Trait is usually benign, but during intense, sustained exercise, hypoxia (lack of Oxygen) in the muscles may cause sickling of red blood cells (red blood cells changing from a normal disc shape to a crescent or “sickle” shape). This can cause accumulation of red blood cells in the bloodstream and a “log jam” of blood vessels leading to collapse from the rapid breakdown of muscles starved of blood and Oxygen.

Sickle Cell Trait Testing: o The NCAA has mandated that all student-athletes have knowledge of their Sickle Cell Trait status before they participate in any intercollegiate athletic events, including strength and conditioning sessions, practices, competitions, etc. ** If you do not wish to be tested for Sickle Cell Trait, please fill out the waiver form below **

SICKLE CELL TRAIT TESTING WAIVER I, ____________________________________, understand and acknowledge that the NCAA and the Northland College Athletic Department mandate that all student-athletes have knowledge of their Sickle Cell Trait status. Additionally, I have read and fully understand the aforementioned facts about Sickle Cell Trait and Sickle Cell Trait testing. Recognizing that my true physical condition is dependent upon an accurate medical history and a full disclosure of any symptoms, complaints, prior injuries, ailments, and/or disabilities experience, I hereby affirm that I have fully disclosed in writing any prior medical history and/or Sickle Cell Trait status to the Northland College Athletic Training staff. I do not wish to undergo Sickle Cell Trait testing as part of my pre-participation physical examination and I voluntarily agree to release, discharge, indemnify, and hold harmless Northland College, its officers, employees, and agents from any and all costs, liabilities, expenses, claims, demands, or causes of action on account of any loss of personal injury that might result from my non-compliance with the mandate of the NCAA and the Northland College Athletic Department. I have read and signed this document with full knowledge of its significance. I further state that I am at least 18 years of age and competent to sign this waiver. __________________________________________ Student-Athlete Signature

__________________ Date

__________________________________________ Parent Signature (If under 18)

__________________ Date

Sickle Cell Trait Verification Student-Athlete: ___________________________

Sport: ______________________

Date of Birth: ______________________________

Year of Eligibility: 1 2 3 4

Date of Sickle Cell Trait test: __________________ Results of the Sickle Cell Trait test:

Negative: _____________ Positive: ______________

Physical activity restrictions:

No restrictions: _________ Restricted to: _________________________________________

I verify that the above named individual has been tested for Sickle Cell Trait. Physician’s Signature: __________________________

Date: _______________________

Printed Physician’s Name: _______________________ Physician’s Address:

_________________________ _________________________

Paperwork should be returned to: Athletic Training- Northland College 1411 Ellis Ave Ashland, WI 54806 [email protected]

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